Provider Demographics
NPI:1629103858
Name:CUMBERLAND PSYCHIATRIC GROUP
Entity Type:Organization
Organization Name:CUMBERLAND PSYCHIATRIC GROUP
Other - Org Name:CPG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:NIGHTINGALE
Authorized Official - Last Name:BRAZIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-436-9700
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30077-1509
Mailing Address - Country:US
Mailing Address - Phone:770-436-9700
Mailing Address - Fax:678-736-7308
Practice Address - Street 1:11111 HOUZE RD
Practice Address - Street 2:STE 225
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5663
Practice Address - Country:US
Practice Address - Phone:770-436-9700
Practice Address - Fax:678-736-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1280Medicare PIN